Gilad Twig, MD, PhD, from the Sheba Medical Center in Tel Hashomer, Israel, and colleagues examined the correlation for BMI in late adolescence with diabetes mortality in midlife. BMI values were measured for 2,294,139 Israeli adolescents between 1967 and 2010. The outcome of death attributed to diabetes mellitus (DM) as the underlying cause was obtained by linkage with official national records.

The researchers identified 481 deaths from DM (mean age at death, 50.6 ± 6.6 years) during 42,297,007 person-years of follow-up (median, 18.4 years). From the 25th to the 49th BMI percentile group onward and from a BMI of 20.0 to 22.4 kg/m² onward there was a graded increase in DM mortality. Compared with the fifth to 24th percentiles, overweight (85th to 94th percentiles) and obesity (95th percentile or higher) correlated with hazard ratios of 8.0 and 17.2, respectively, for DM mortality, after adjustment for multiple confounding variables. For the 50th through the 74th percentiles, the hazard ratio was 1.6. The estimated population-attributable fraction for DM mortality was 31.2% for the 1967 to 1977 prevalence of overweight and obesity at age 17, and increased to 52.1% for the 2012 to 2014 prevalence.

"The increasing prevalence of childhood and adolescent overweight and obesity points to a substantially increased future adult DM burden," the authors write.